Healthcare Provider Details

I. General information

NPI: 1043724784
Provider Name (Legal Business Name): HALEY NICOLE LUCE MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW EASTMAN PKWY STE 38
GRESHAM OR
97030-5533
US

IV. Provider business mailing address

912 NE KELLY AVE
GRESHAM OR
97030-5629
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 855-772-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59011
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: